The pathophysiologic and prognostic significance of acidosis in severe adult malaria

Day, Nicholas P. J.; Phu, Nguyen Hoan; Hoang, Nguyen Thi; Chau, Tran Thi Hong; Loc, Pham Phu; Chuong, Ly Van; Sinh, Dinh Xuan; Holloway, Paul; Hien, Tran Tinh; White, Nicholas J.

doi:10.1097/00003246-200006000-00025

Cited by 183 publications

(179 citation statements)

References 22 publications

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“…Abnormal host inflammatory response is one of the possible pathogenetic mechanisms in severe malaria. Parasite load was inferior in predicting subsequent mortality [11]. Early diagnosis and risk stratification are crucial for preventing complications in malaria.…”

Section: Introductionmentioning

confidence: 99%

“…Many of the malarial complications are inflammatory in nature [6]. Abnormal inflammatory host response is the possible pathogenetic mechanism in severe malaria [11]. At the cellular level, various proinflammatory cytokines and several adhesion molecules play important roles in the pathogenesis of complicated malaria [7], and CRP and increased erythrocyte sedimentation rate (ESR) might represent this state of inflammation.…”

Section: Introductionmentioning

confidence: 99%

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Pretreatment elevated erythrocyte sedimentation rate and C-reactive protein as a predictor of malarial complications

Vemula

Vidyalakshmi

Unnikrishnan

et al. 2016

J Infect Dev Ctries

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Introduction: Complications of malaria can develop suddenly and unexpectedly. Although various parameters have been associated with severity of malaria, they have not been studied as predictors of these events. Many of the malarial complications are inflammatory in nature, and C-reactive protein (CRP) and elevated erythrocyte sedimentation rate (ESR) could be early markers of these complications and might precede and predict the development of complications. Methodology: A total of 122 inpatients with uncomplicated newly diagnosed malaria were studied. CRP, ESR, hemoglobin, and platelets were measured before initiating treatment. Patients were monitored closely for the subsequent development of complications based on the World Health Organization's definition of severe malaria. Results: Seven patients (5.7%) had worsening of symptoms compared to the day of admission and had higher pretreatment CRP and increased ESR compared to those patients who did not develop complications. Area under receiver operator characteristic curve was 0.761(p=0.02) for CRP and 0.739 (p = 0.035) for ESR. CRP>124 mg/L and increased ESR (>34.5 mm in the first hour) had a sensitivity of 71.4% and specificity of 79.1%, respectively, for predicting complications of malaria. Other parameters did not reach statistical significance for predicting complications. Elevated CRP and elevated ESR had a negative predictive value of 97.8%. Conclusions: Elevated CRP>124mg/L and increased ESR>34.5 mm in the first hour at the time of diagnosis in patients with uncomplicated malaria identifies patients who might subsequently develop complications of malaria.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pretreatment elevated erythrocyte sedimentation rate and C-reactive protein as a predictor of malarial complications

Vemula

Vidyalakshmi

Unnikrishnan

et al. 2016

J Infect Dev Ctries

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“…Acidosis, already exists in renal disease, and is worsened in falciparum malaria comorbidity. Falciparum malaria causes lactic acidosis due to anaerobic glycolysis of hypoxic tissue (13). Coma and acidosis are significant prognostic factors of mortality from severe malaria (14).…”

Section: Discussionmentioning

confidence: 99%

A Lethal Case of Plasmodium falciparum Infection in a Young Patient with End-stage Renal Failure Who Underwent Regular Hemodialysis

Hartopo

Wijisaksono

2010

Intern. Med.

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Acute renal failure associated with Plasmodium falciparum infection is already well recognized. Nevertheless, end-stage chronic renal failure and falciparum malaria comorbidity is a rare condition. We report a case of Plasmodium falciparum infection in a young male Javanese patient with end-stage chronic renal failure who underwent regular hemodialysis. This rare comorbidity led to rapid deterioration of consciousness and metabolic disturbances which had already existed in end-stage renal failure. Because of the immunosuppressive condition due to organ failure, the patient did not survive despite anti-malarial chemotherapy.

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“…The presence and degree of acidosis is an important predictor of mortality and should alert the clinician to the severity of the disease. 71 Microvascular obstruction with resultant tissue hypoxia and anerobic glycolysis are the main drivers of lactic acidosis. Caution should be taken against an overly aggressive fluid resuscitation strategy, which is often an initial treatment response for severe lactic acidosis.…”

Section: Metabolicmentioning

confidence: 99%

Perioperative considerations of the patient with malaria

Soltanifar

Carvalho

Sultan

2014

Can J Anesth/J Can Anesth

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Purpose Malaria is a life-threatening infectious disease caused by the Plasmodium parasite. Increased global travel has resulted in an escalation in the number of imported cases seen in developed countries. Patients with malaria may present for surgery in both endemic and nonendemic countries. This article reviews the perioperative considerations when managing patients with malaria. Source A literature review of anesthesia, perioperative care, and malaria-related articles was performed using the MEDLINE Ò , EMBASE TM , and Web of Science databases to identify relevant articles published in English during . Of the 303 articles matching the search criteria, 265 were excluded based on title and abstract. Eleven of the remaining 38 articles were relevant to anesthesia/perioperative care, and 27 articles were identified as having direct relevance to critical care medicine. Principal findings The majority of imported malaria cases are caused by the falciparum species, which is associated with the greatest degree of morbidity and mortality. Various organ systems may be impacted as a consequence of changes in the structure and function of parasitized erythrocytes. Preoperative assessment should focus on establishing the species of malaria, the severity of disease, assessing the degree of end-organ impairment, and initiating treatment of malaria prior to surgery. Intravenous artesunate is the treatment of choice for severe falciparum malaria. Quinine is a second-line agent but has a narrow therapeutic index and particularly hazardous side effects. Intraoperatively, attention should focus on fluid management, dynamics of cerebral blood flow, and avoidance of hypoglycemia. Postoperative care of severe cases should ideally take place in a critical care unit as there may be ongoing requirements for multi-organ support, including renal replacement therapy, ventilation, and/or inotropic support. The safety of neuraxial anesthesia has not been well studied in the setting of malaria. Conclusions Malaria remains one of the most devastating infectious diseases worldwide. Multiple organ systems can be impacted as a consequence of changes in structure and function of parasitized erythrocytes. Safe perioperative management requires a sound knowledge of all these potential system effects. RésuméObjectif Le paludisme est une maladie infectieuse possiblement fatale due au parasite Plasmodium. La multiplication des voyages à travers le monde a entraîné un accroissement du nombre de cas importés observés dans les pays développés. Les patients atteints de paludisme peuvent nécessiter une chirurgie, aussi bien dans les pays où la maladie est endémique que dans les autres. Cet article passe en revue les considérations périopératoires lors de la prise en charge de patients atteints de paludisme. Source Une revue de la littérature à la recherche d'articles d'anesthésie, de soins périopératoires et en Author contributions Daniel Soltanifar, Brendan Carvalho, and Pervez Sultan all made substantial contributions to the literature review, ...

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The pathophysiologic and prognostic significance of acidosis in severe adult malaria

Abstract: These results confirm the importance of acidosis in the pathophysiology of severe adult malaria and suggest a multifactorial origin involving tissue hypoxia, liver dysfunction, and impaired renal handling of bicarbonate.

Cited by 183 publications

References 22 publications

Pretreatment elevated erythrocyte sedimentation rate and C-reactive protein as a predictor of malarial complications

Pretreatment elevated erythrocyte sedimentation rate and C-reactive protein as a predictor of malarial complications

A Lethal Case of Plasmodium falciparum Infection in a Young Patient with End-stage Renal Failure Who Underwent Regular Hemodialysis

Perioperative considerations of the patient with malaria

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